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(Supplemental Form) <br /> <br />In. o~der to properly evaluate your existing sewage system, the following <br />informat%on will be necessary: <br /> <br />r~ your sewage system is less than five (5) years old, and we <br />have an approved reoo~d of the system, we can proceed without <br />any further action on your part. <br /> <br />If Hour sewage system is less than five (5) years old, and we <br />do not have a record of an approved installation of the system: <br /> <br /> or; <br />If your sewage system is more than five (5) Hears old or ]]as no~ <br />been pumped within the last five years: <br /> <br />a. You must have the septic tank pumped. <br />b. Have the septic tank pumper complete the form below. <br />e. A field visit will be required by the Sanitarian ~o <br /> verify the location and condition o.f the septic system. <br />d. If you have proof that your Septic tank has been <br /> pumped within the last five (5) years, sections a & b <br /> will no~ be required. <br /> <br />-For Septic Tank Pumper Use Only- <br /> <br />co,~pANz NA;3E: Steyton Septic Service <br /> <br />DEQ ~ICENSE NO: 34916 <br /> <br />PROPERTY OWNER: <br /> <br />ADDRESS WHERE TANK PUMPED= <br /> <br />Earl Johnson <br /> <br />8754 Mill Creak Rd S.E. <br /> <br /> .... ~%ums v i 1,~,.e..a' OR <br />APPROXIMATE SIZE OF SEPTIC TANK: 1000 .......... --gallons concrete <br />IS ~ANK IN GOOD CONDITION? XX YES; NO <br /> <br />ARE BAFFLES OR ELBOWS IN P~CE? <br /> <br />X~ YES; NO <br /> <br />IS DRAINFIELD BACKING UP INTO TANK? <br /> <br />YES; X~ NO <br /> <br />If yes, explain; <br /> <br />DIACRI~; OF HOUSE AND <br />LOCATION OF <br /> <br />EX:~IPLE : <br /> <br /> <br />